EP244 - Patient Perspectives after undergoing Total Neoadjuvant Therapy (TNT) for rectal cancer- a qualitative study.

Purpose/Background: Over the past few years adoption of total neoadjuvant treatment (TNT) regimens for management of locally advanced rectal cancer has become standard. As indications for TNT increase including improving survival and organ preservation, it is important for clinicians to evaluate the patient experiences during treatment and understand functional outcomes post-treatment to better inform treatment algorithms. The aim of our study was to interview patients with rectal cancer treated with TNT to understand the patient perspective after undergoing TNT, their post-treatment bowel, bladder and sexual function, and identify potential areas for improvement.

Methods/Interventions: A qualitative study was performed via virtual semi-structured patient interviews. Inclusion criteria was adult patients treated with TNT for rectal cancer who were diagnosed and treated in the province of Alberta and were within 6-12 months of treatment completion. Interviews were transcribed and thematic analysis was done using NVivo. Ethics approval was obtained from the University of Calgary, HREBA CC.23-0020.

Results/Outcomes: 12 individuals were interviewed, with a median age of diagnosis of 63 years (IQR 50.1-69 years), 7/12 male (58%), and 5/12 (42%) had non-operative management. Patients had self-reported low levels of rectal cancer knowledge prior to starting treatment. We identified 3 themes from the diagnosis phase: trust in the clinical team, information seeking, and desire to avoid a stoma (Table 1). We identified 3 themes from the treatment phase: coping with side effects, use of support systems, and patient resilience in their new normal (Table 2). Patient reported post-treatment side effects were mainly bowel-related and most maintained a positive attitude. There were 2 themes identified for future improvement: specialized clinical support, and peer support (Table 2).

Conclusion/Discussion: Patients undergoing TNT place their trust in the clinical team's expertise with a common theme of hoping to avoid a stoma. Although some may underestimate the side effects associated with treatment, patients describe robust support systems as important for coping. Post-treatment poor bowel-function is the most discussed side effect, and future studies should focus on understanding the allied-health or peer-based support systems that could be implemented in our health care region.

Table 1
Representative Quotes from Patient Interviews- Diagnosis
Table 2
Representative Quotes from Patient Interviews- Treatment and Improvements